The management of cytologically indeterminate thyroid nodules in clinical practice: A contemporary perspective with...

Thyroid nodules are commonly encountered in clinical practice and can be detected by palpation and ultrasound in about 5 and 70% of cases, respectively. Excluding thyroid cancer is the most relevant task when assessing a thyroid nodule, as only 5-10% of evaluated thyroid nodules are malignant. Fine-needle aspiration cytology (FNAC) is pivotal in detecting or excluding malignancy; however, cytologically indeterminate findings occur in up to 30% of cases and carry a malignancy risk ranging from 10-40%. Diagnostic surgery was traditionally performed in such cases resulting, however, in futile procedures in approximately 75% of cases. Accordingly, more accurate diagnostic strategies are warranted. Various methods are currently available to support clinical decision-making, including core needle biopsy (CNB) and multiple molecular testing. In addition, molecular imaging methods have emerged as a valuable tool for stratifying cytologically indeterminate nodules and guiding clinicians in making informed clinical decisions. We aim to describe the basis of thyroid molecular imaging, its clinical use in patients with indeterminate thyroid nodules, and its potential role in the context of different available methods.